State of Health » HIV/AIDShttp://ww2.kqed.org/stateofhealth
KQED Public Media for Northern CASun, 02 Aug 2015 05:01:14 +0000en-UShourly1http://wordpress.org/?v=4.2.2Future of Program for Low-Income HIV/AIDS Patients Unclear After Obamacarehttp://ww2.kqed.org/stateofhealth/2013/11/20/future-of-program-for-low-income-hivaids-patients-unclear-after-obamacare/
http://ww2.kqed.org/stateofhealth/2013/11/20/future-of-program-for-low-income-hivaids-patients-unclear-after-obamacare/#commentsWed, 20 Nov 2013 19:57:33 +0000http://blogs.kqed.org/stateofhealth/?p=16310Sharon Wilson, 53, picks up her weekly allotment of produce from the AIDS Project of the East Bay. Wilson, who has HIV, says without help, she couldn’t afford to buy fresh vegetables. (Angela Hart/KQED)

By Angela Hart

Several times each week, Sharon Wilson, a 53-year-old HIV-positive retired caregiver, takes an hour-long bus ride from her Berkeley home to her clinic in downtown Oakland. Wilson doesn’t mind making the trip, because she says the care she has received there since her diagnosis has saved her life.

Wilson says multiple chronic diseases, including HIV, have made it impossible for her to work. Ensuing financial struggles make managing her disease increasingly difficult.

“I can’t afford healthy food and all the medications I need to take,” Wilson said as she described her strict antiretroviral drug regimen. “It’s not easy to learn a new way of living. I take a handful of pills when I wake up in the morning, a handful of pills with lunch, and another handful before I go to bed.”

For people like Wilson, the AIDS Project of the East Bay — one of Alameda County’s six HIV specialty clinics — is a place of refuge. There, Wilson has received primary care for her HIV and specialty care since 2006. She’s been referred to Oakland’s Highland Hospital multiple times to treat other chronic conditions, including congestive heart failure and arthritis.

But Wilson said equally important to her medical care is the bevy of other resources the clinic provides: food, housing assistance, free transportation, nutrition classes, and substance abuse counseling.

“This place is the reason I’m not homeless — it’s my lifeline,” she said on a recent day as she picked up her weekly allotment of vegetables.

It’s because of a federal program commonly referred to as Ryan White that clinics like AIDS Project of the East Bay can afford to provide that range of other services, in addition to primary and specialty care. Ryan White funds are divvied out to clinics that offer these services for low-income, HIV-positive patients and people with AIDS to provide a broad spectrum of care — from being able to purchase a bus ticket, to scheduling a medical appointment, to buying groceries with food vouchers.

For Wilson and hundreds of others in Alameda County who are poor and chronically ill, the program is critical. Ryan White, passed by Congress in 1990 to provide life-saving health care for the poor and uninsured, is credited with building some of the first effective coordinated care for people with the disease.

But the future of Ryan White is uncertain.

The program expired at the end of September, although Congress approved its continuance without an official reauthorization.

As of Jan. 1, as part of the Affordable Care Act, California is expanding Medi-Cal, the state’s version of Medicaid, and will allow childless adults making less than $15,856 a year to sign up.

That means that the vast majority of low-income Californians who currently use Ryan White funds for their medical care will move into Medi-Cal on Jan. 1.

The transition of poor, sick people living with HIV or AIDS moving from one public program to another has ignited concerns among patient advocates and nonprofits that provide care for a population whose health relies on stable medical homes and expensive antiretroviral medications.

Patient advocates say Ryan White remains important because it can pay for the other necessities that HIV/AIDS patients find crucial.

“Health reform has been challenging for us in a number of ways,” said Alvan Quamina, the executive director for the AIDS Project of the East Bay, which provides services for about 700 people in Alameda County annually. “Though long-term benefits are obvious, health reform means funding streams for HIV services are in jeopardy.”

Alameda County HIV specialists argue that Ryan White is critical for clinics to provide the services that make daily life possible: transportation, counseling, housing assistance, and emergency food..

“Ryan White will continue to be important to provide the ancillary support services,” Quamina said. “While primary care transitioning to Medi-Cal, Ryan White can pay for things like BART fare or a free bus pass, food vouchers, and peer counseling,” he said.

PUBLIC HEALTH BENEFIT

Keith Waltrip, the acting director for the Alameda County Office of AIDS Administration, agreed that Ryan White is critical to ensure a continuum of care for patients with sensitive health needs.

“Support services help get these low-income people into care,” Waltrip said. “So making sure they have transportation, and healthy food, and psycho-social services is important. Those services aren’t going to be paid for under Medi-Cal, so that’s where Ryan White comes in.”

Waltrip said those services benefit not only the health of an individual, but also the health of a community.

“There is a public health benefit of keeping patients in care,” Waltrip said. “Continuous treatment reduces their viral load, and decreases their chances of passing along HIV to another individual, thus reducing the number of infections in a community.”

Kathleen Clanon is an HIV specialist and the interim chief medical officer for the Health Program of Alameda County. She is overseeing the transition of Ryan White patients to Medi-Cal.

Clanon said Alameda County is ahead of the curve in aggressively preparing for the transition of Ryan White patients to Medi-Cal, or Covered California — whichever program patients are eligible for, depending on income.

Each of the county’s six HIV specialty clinics will welcome new Medi-Cal patients after ACA implementation — something the county has been negotiating since January. That will mean better access to health care for the low income and a reduction in the likelihood for patients having to switch providers, Clanon said.

Though the long-term future of Ryan White is uncertain, Clanon said she expects it to remain in place at least through 2014, in some capacity.

Other county health officials agreed, and said that meanwhile, HIV workers are advocating for the program’s continuance at the local, state and federal levels.

“It’s unclear where we’re headed, and it really doesn’t look good,” Quamina said. “What we’re hearing is we should start planning, but my response is we’re going to prepare, but we need to fight.”

For patients like Wilson, the shaky future of the program that she relies on is worrisome.

“I just hope we can get people educated about what’s happening, so we can keep getting the assistance we depend on,” she said.

]]>http://ww2.kqed.org/stateofhealth/2013/11/20/future-of-program-for-low-income-hivaids-patients-unclear-after-obamacare/feed/0Sharon WilsonSharon Wilson, 53, picks up her weekly allotment of produce from the AIDS Project of the East Bay. Wilson, who has HIV, says without help, she couldn't afford to buy fresh vegetables. (Angela Hart/KQED)Doctors Fear HIV Patients Will Fall Through Cracks As Obamacare Rolls Outhttp://ww2.kqed.org/stateofhealth/2013/04/26/doctors-fear-hiv-patients-will-fall-through-cracks-as-obamacare-rolls-out/
http://ww2.kqed.org/stateofhealth/2013/04/26/doctors-fear-hiv-patients-will-fall-through-cracks-as-obamacare-rolls-out/#commentsFri, 26 Apr 2013 13:42:16 +0000http://blogs.kqed.org/stateofhealth/?p=12366Public health implications as people who stop taking HIV medications can quickly become infectiousDr. Kathleen Clanon talks to patient Andrew Solis about keeping his HIV under control. Clanon worries her patients will have disruptions in their care if they don’t navigate the changes coming under federal health reform. (Mina Kim/KQED)

A major goal of the federal health care law is that millions of people who currently do not have health insurance will have improved access to care. But the massive overhaul is also expected to be widely disruptive, and doctors worry that many people with chronic illness could suffer during the changeover, as KQED’s Mina Kim details today on The California Report.

Kim tells the story of 33-year-old Andrew Solis who stopped taking HIV medications more than a year ago after becoming addicted to methamphetamine while in a “rocky relationship.” He resumed treatment at the Oakland Highland Hospital HIV clinic last October after ending the relationship.

Solis has been able to get back in to treatment fairly easily, Kiim reports. But changes coming under the Affordable Care Act could complicate care for clinic patients, says Kathleen Clanon, chief medical officer at Highland Hospital.

From Kim’s report:

“They are all poor basically. It’s been 15 years or so since HIV was really a disease in the U.S. of middle-class men. It’s been a disease of poverty in the U.S., really, for about 15 years now.”

Right now, low-income patients without insurance get their health care paid for by the federal Ryan White program which only covers HIV related care. In order for them to get the full benefits of the Affordable Care Act, they’ll need to move to a more traditional insurance-based care. For starters, they’ll have to first choose an insurance carrier and a primary care doctor and Clanon says, that won’t always be easy.

“Most of the information that goes to people about their choices and how they’re becoming insured is going to come by snail mail, and people who are low-income frequently don’t have stable addresses, and the majority of my patients don’t have regular access to the internet.”

If her patients don’t fill out the paperwork, they will be automatically assigned to a primary doctor — one that Clanon says is unlikely to have a specialty in HIV care. Or worse, she fears her patients won’t tell their new doctor that they’re infected, because of stigma surrounding people with the virus.

“I have a patient that I saw about a month ago, he needed to move in with his mom. However she was so afraid of him that she was making him eat in his room off paper plates that she would then throw away. So stigma will make it difficult for people to fix any weirdness that happens in terms of where they get assigned.”

And people with HIV, Clanon says, don’t have time to be away from treatment.

“Within a week, ten days, two weeks, if you stop taking your HIV medication, the virus comes back. And treatment interruptions are dangerous for people with HIV, they’re dangerous for their health, and they’re dangerous for our whole community because during that time that person is infectious to others.”

Still, the Affordable Care Act earmarks money to deal with all that paperwork. Covered California, the state’s new health insurance marketplace will soon announce grants totaling $49 million for education and outreach. Much of the money is expected to be awarded to community groups which have extensive networks in ethnic and low-income populations — the very people who might have the most trouble navigating the new system.

The primary goal of that outreach is simply to get people enrolled in a health insurance plan. But Dana Howard, a spokesman with Covered California says these “assisters” will also be charged with helping people directly. “Assisters are there to say, ‘Let’s figure out who you’re seeing. Let’s find a plan that has your network in there and find the one that has the best price,'” Howard described.

Anthony Wright of Health Access, a statewide consumer advocacy group, was a bit more circumspect, saying, “that is the hope” when asked if assisters would help make sure people made it into a plan that includes their current doctor.

In the meantime, Dr. Clanon is moving ahead on her own, Kim reports. Two staff members at Highland’s HIV clinic are becoming experts in the Affordable Care Act. They’re also working with insurance plans to make sure that one of their HIV/AIDS doctors can be listed as a primary care provider.

Again, from Kim’s report:

Clanon says her clinic is ahead of the game, but she worries about clinics in rural areas or clinics with fewer resources. To help them along, Clanon’s been traveling up and down the state talking with other HIV providers about ways to prepare for health reform.

This post has been updated to include a quote and information from Dana Howard of Covered California. It also corrects the amount of money to be granted for education and outreach.

]]>http://ww2.kqed.org/stateofhealth/2013/04/26/doctors-fear-hiv-patients-will-fall-through-cracks-as-obamacare-rolls-out/feed/0HIV_KathleenClanon_MinaKimDr. Kathleen Clanon talks to patient Andrew Solis about keeping his HIV under control. Clanon worries her patients will have disruptions in their care if they don't navigate the changes coming under federal health reform. (Mina Kim/KQED)Researchers Report First Cure of HIV in a Child; Reaction in Californiahttp://ww2.kqed.org/stateofhealth/2013/03/04/researchers-report-first-cure-of-hiv-in-a-child-reaction-in-california/
http://ww2.kqed.org/stateofhealth/2013/03/04/researchers-report-first-cure-of-hiv-in-a-child-reaction-in-california/#commentsTue, 05 Mar 2013 00:58:50 +0000http://blogs.kqed.org/stateofhealth/?p=11009Antiretroviral medicines are used to treat HIV/AIDS. (Sonny Tumbelaka/AFP/Getty Images)

A baby born with HIV, the virus that causes AIDS, appears to have been cured, scientists announced at a meeting on Sunday in Atlanta. They described the case of a child — as yet unnamed — from Mississippi who is now 2 1/2. The child has been off medication for about a year and appears to be free of infection.

From AP:

There’s no guarantee the child will remain healthy, although sophisticated testing uncovered just traces of the virus’ genetic material still lingering. If so, it would mark only the world’s second reported cure.

Specialists say Sunday’s announcement, at a major AIDS meeting in Atlanta, offers promising clues for efforts to eliminate HIV infection in children, especially in AIDS-plagued African countries where too many babies are born with the virus.

“You could call this about as close to a cure, if not a cure, that we’ve seen,” Dr. Anthony Fauci of the National Institutes of Health, who is familiar with the findings, told The Associated Press.

Here in California, researchers have been electrified by the news. California reported the largest number of HIV diagnoses in the country in 2011, according to the Centers for Disease Control. More than 60 percent of Californians with HIV live in Los Angeles or San Francisco.

Dr. Deborah Cohan, an obstetrician at UC San Francisco, who specializes in the care of pregnant women with HIV was at the conference in Atlanta and described to Mina Kim how the discovery might impact her work.

“There are many things we have already been doing in San Francisco,” Cohan said. “The most important piece is that we’ve been successful at essentially eliminating HIV transmission to babies. In this case, the baby was infected wiht HIV at birth, and we have been exceptionally successful at preventing that from happening to begin with. The last case of HIV transmission we had in a baby in San Fancisco was in 2004.”

Mother-to-baby transmissions in the U.S. are fairly uncommon — about 130 a year. Where this discovery may have significant implications, Cohan says, is in sub-Saharan Africa, where new infections in babies are much more common.

“One of the things this points to is the importance of early diagnosis of HIV in babies,” Cohan said. “Currently national guidelines considers it optional to do a birth test on an HIV-exposed baby. The national recommendations are that it should be done in the first two weeks of life. In this case, they did a birth testing, and that really had an impact on how they ended up managing the baby because the baby was diagnosed so early.”

Cohan said this child’s case could have an impact on national guidelines and national recommendations. Currently, if a child is HIV positive at birth, the recommendation is a lifetime of antiretroviral medications, which is expensive and come with side effects.

“While in general we think these medications are safe, taken over a long period of time and for very early exposure with an HIV-infected baby, certainly there are cumulative toxicities that can occur, so if that can be avoided, certainly that would be an optimal strategy.”

The only other case of an HIV/AIDS cure is that of Timothy Brown, the so-called Berlin Patient. As a treatment for cancer, he received a bone marrow transplant in Germany from a donor who was genetically resistant to HIV.

]]>http://ww2.kqed.org/stateofhealth/2013/03/04/researchers-report-first-cure-of-hiv-in-a-child-reaction-in-california/feed/5Boxes of antiretroviral medicines sit onAntiretroviral medicines are used to treat HIV/AIDS. (SONNYTUMBELAKA/AFP/Getty Images)Rethinking Unprotected Sex for HIV-Positive Menhttp://ww2.kqed.org/stateofhealth/2013/02/15/permission-to-forego-condoms-for-hiv-men-wanting-children/
http://ww2.kqed.org/stateofhealth/2013/02/15/permission-to-forego-condoms-for-hiv-men-wanting-children/#commentsFri, 15 Feb 2013 18:43:48 +0000http://blogs.kqed.org/stateofhealth/?p=10609By Mina Kim
Deon, 32, is HIV positive and expecting a daughter. He’s being treated at a new San Francisco program that helps men with HIV safely realize their dreams of being dads. (Photo: Ryan Anson)

The public health message around unprotected sex for those with HIV has always been the same: Don’t do it. Even with huge strides in medical science that’s changed HIV from a death sentence to a chronic but manageable disease, that directive has not changed.

Now, a new program based in San Francisco is challenging this long-held campaign, and helping HIV-positive men have babies — the conventional way. The program run by San Francisco General Hospital, called PRO Men, teaches men about a range of reproductive options, from adoption to in vitro fertilization — where an egg is fertilized in a lab dish — to carefully timed intercourse.

“I would say as an HIV provider community, we have really failed these men,” says UCSF professor Deborah Cohan, who runs the hospital’s Bay Area Perinatal AIDS Center or BAPAC. “We really have not created programs to help them realize those goals and do so safely.”

“It is one of the last big remaining hurdles that I think many heterosexual men and women have to what they would consider living a normal, ordinary life.”

With the discovery of drugs to treat the virus, Cohan said people with HIV are living long, healthy lives. And for those who want to start families, having “safe” sex, Cohan said, can mean foregoing condoms when a female partner is ovulating. Women can also take HIV drugs, which some studies show can protect against the virus. (BAPAC has helped HIV-positive women who adhere to their medications have healthy babies for years.)

“We know that if the person who is positive takes antiretrovirals and their viral load is suppressed, meaning the medication is working at killing all the HIV in the blood, that the likelihood of them passing HIV to a sexual partner is essentially zero,” Cohan said.

“Essentially zero” but not absolutely zero, Cohan says, because there’s some concern the virus can be in genital fluid even when it’s not detected in blood.

Despite this concern, couples are forging ahead with their family plans. Deon, 32, who thought his life was over when he tested HIV positive when he was in jail four years ago. Now he is about to welcome a baby girl with his fiancée Caroline. (Both Deon and Caroline preferred to go by their first names only.)

The couple became pregnant through unprotected sexual intercourse. Caroline does not have HIV, so the baby does not either. And she said she’s really not too concerned about getting HIV from her partner.

“He’s on his meds, and it’s a really, really, really low chance of me getting it,” she said. “And I just, like I love him, it’s not a big issue.”

BREAKING STIGMA

Though it may not be a big issue for Caroline, being HIV positive and having unprotected sex runs counter to just about every public health message that’s been put out for decades. Both state public health officials and officials with the Centers for Disease Control declined to comment for this story. The latest ethics report from the research and advocacy group American Society for Reproductive Medicine called the practice, “unsafe” and “not recommended.”

The San Francisco program is thought to be the first of its kind, and David Evans with the AIDS activist group Project Inform said it may stay that way for a while.

“I think stigma is still very, very strong in society about HIV in general.”

Evans, who has been following HIV medical science for decades and pushes for policy changes, said that in some states, doctors have refused to help those with HIV have kids altogether. Until about two years ago, health officials in Mississippi required people who tested positive for the virus to sign a form saying they would never have children. Evans said a program that affirms the right of people with HIV to have kids, and let go of condoms, could be revolutionary.

“I think this really changes things in a quite dramatic way,” Evan said. “And it is one of the last big remaining hurdles that I think many heterosexual men and women have to what they would consider living a normal, ordinary life.”

Case in point, as a typical father-to-be, Deon worries more about raising a daughter than he does about his HIV.

“It’s like ‘Oh my god,’” he said. “I definitely want her to know all kinds of self-defense. I envision her to be a black belt in karate.”

Caroline said she’s confident they’ll be good parents.

“We just have a really good relationship, like we really talk about everything,” she said. “He says I can make the decisions, but we make decisions together really, and things are just better when we’re together.”

The hospital treats about 500 straight men with HIV. The PRO Men program plans to launch a monthly support group in March that will also be open to men living outside San Francisco.

Listen to Mina Kim’s story:

]]>http://ww2.kqed.org/stateofhealth/2013/02/15/permission-to-forego-condoms-for-hiv-men-wanting-children/feed/8Deon, 32, is HIV positive and expecting a daughter. He’s being treated by a new San Francisco program that helps men with HIV safely realize their dreams of being dads. (Photo: Ryan Anson)Deon, 32, is HIV positive and expecting a daughter. He’s being treated by a new San Francisco program that helps men with HIV safely realize their dreams of being dads. (Photo: Ryan Anson)Homeless Young People Find Help at Larkin Street Youth Services in SFhttp://ww2.kqed.org/stateofhealth/2012/11/30/homeless-young-people-find-help-at-larkin-street-youth-services-in-sf/
http://ww2.kqed.org/stateofhealth/2012/11/30/homeless-young-people-find-help-at-larkin-street-youth-services-in-sf/#commentsSat, 01 Dec 2012 00:08:18 +0000http://blogs.kqed.org/stateofhealth/?p=9187The news this week from the Centers for Disease Control about HIV and young people may have startled some, but to people who work at San Francisco’s Larkin Street Youth Services, it was a spotlight on what they see every day.

More than a quarter of all new infections every year are in young people between ages 13 and 24 — and more than half of those youth infected don’t know it. Hardest hit are African Americans — 57 percent of people in this young age group.

In advance of World AIDS Day on Saturday, The California Report’s host Rachael Myrow visited Larkin Street Youth Services, which helps homeless teens get off the streets and get tested for HIV. She talked to two women who manage programs at the organization.

Here is an edited transcript of their discussion:

LARA TANNENBAUM, Larkin Street’s housing programs: The majority of our youth have experienced a severe amount of abuse or neglect in the home, parental substance use, perhaps a lot of poverty in the home where families weren’t able to care for them. Many of our clients are LGBT and their parents asked them to leave because of their sexual orientation. So people really become homeless for a variety of reasons.

RACHAEL MYROW: How do you start a conversation with a teenager about HIV/AIDS?

RAE SUBER, Larkin Street’s HIV testing & prevention program: Getting a client to consider testing is like getting them to consider medical care in general. Usually there’s a crisis. They think they might have a sexually transmitted infection. They think they might be pregnant. They think their partner might have an infection or be pregnant, and they’re concerned. So they come in and, if testing is indicated, we’ll recommend it.

RACHAEL MYROW: What is it that stands between a young person who may be homeless or may be insecure about their housing situation and medical care in general?

LARA TANNENBAUM: There are a lot of barriers that prevent young people from thinking about HIV prevention and testing while they are on the streets. Just meeting basic needs is really the primary thing on most of our youths’ mind — finding a place to stay for the night, having food.

In addition, the things that youth have to do to survive for the night on the streets put them at higher risk for HIV. Many of our youth engage in what we call “survival sex,” trading sex for food or a place to stay, or even money. Very often in those interactions, youth are not able to negotiate safer sex, so that puts them at risk for HIV. Many of our youth on the streets are using substances as part of their coping mechanism. They may be using intravenous drugs; they may be sharing needles. That puts them at risk for HIV. So there are a lot of risk factors for homeless youth as well as a lot of barriers to getting them tested.

RACHAEL MYROW: There have been a number of reports that point to new infections coming primarily among men and teenage boys who have sex with other men and teenage boys — and new infections are high among African Americans. Have you decided to tailor your programs any differently, in light of these reports, or is it just something you bear in mind as you do your work?

LARA TANNENBAUM: The statistics are really alarming nationwide. The disproportionality of HIV infection is really concerning. If you are a young person, if you are a man who has sex with men, if you are a man of color who’s a young person — who has sex with men — you are at extremely high risk of HIV in the United States, and we see that in our programs. Of the 70 to 80 HIV positive youth a year who we serve, the vast majority are young men of color who have sex with men.

RACHAEL MYROW: If you’re a traveler, if you’re having sex in circles where there’s already a higher incidence of HIV infection, you’re at a statistically higher risk.

LARA TANNENBAUM: Absolutely. Part of what we try to do when we identify someone who is positive is encourage them to have their friends get tested. We’re very much aware that homeless youth in particular are travelers and do tend to have social networks, and there’s a lot of potentially drug use and/or sexual partners within those networks and so the risk can be very high in those networks. We do see sometimes youth who come into our program for positive youth, we have had occasion where a young person will come in, and then a friend comes in, and then another friend comes in, so we’ve actually see that play out.

Researchers, doctors, advocates and general attendees at this year’s International AIDS Conference were awash in enthusiasm that a cure to the AIDS epidemic is actually within reach, largely due to advances in treatments and improved prevention.

But to actually reach the cure takes money. And right at this moment, private funding is down.

Dramatically.

Funders Concerned About AIDS, a philanthropy dedicated to ensuring the end of the epidemic, says both the number of grants from private foundations and actual dollars given have dropped by about one-third.

While the new infections are among people at the intersection of race and poverty, the traditional funders of HIV/AIDS … look around at their friends and may get the sense AIDS is “solved.”

At first blush, it would seem that a down economy would be a big driver, but Daniel Tietz, Executive Director of the AIDS Community Research Initiative of America (ACRIA), sees something else at work. He spoke with KQED’s Rachael Myrow on The California Report Friday morning and said that the downturn in funding predated the downturn in the economy.

“If you look back at 2006, 2007, the economy was booming, but the drops were starting even then, both in total grant numbers and total dollars.” At the same time, funding to other lesbian, gay, bisexual and transgender giving such as marriage equality and the repeal of the military’s “Don’t Ask, Don’t Tell” policy have gone up. “It’s also worth noting,” Tietz continued, “that many foundations do three year averages in terms of their investments, in terms of what they give, so we would just be seeing some of those decreases now if it were just a matter of the economy.”

So, what is going on? Tietz asserts it has to do with the success of HIV/AIDS treatments and what groups are — and are not — benefiting from them. Despite the success in the battle against AIDS, 50-thousand people are infected every year and a wildly disproportionate number of those new infections are in African-Americans.

As Tietz wrote in a Washington Post opinion piece last summer as the AIDS Conference kicked off:

More than six in 10 new infections in the United States are among men who have sex with men, known in this field as MSM. Within that group, the hardest-hit are African American men ages 13 to 29. From 2006 to 2009, CDC data show, HIV infections rose by an appalling 48 percent among these young men — one of the largest increases of any demographic. New HIV cases among black MSM are nearly equal to those for their white counterparts, despite the former’s far smaller percentage of the population.

So, Tietz says, while the new infections are among people at the intersection of race and poverty, the traditional funders of HIV/AIDS — wealthy, gay, white philanthropists — look around at their friends and may get the sense AIDS is “solved.”

“Today, you may not even know who has HIV,” he says. “They could have HIV, they can be in treatment. You don’t see deaths, you don’t see people in rapid decline. It can feel solved. It can feel like ‘OK, I can move on, I can give my resources to marriage equality, I can give my resources to whatever else in the world.”

But obviously AIDS is far from solved. Tietz says he has gotten some “quiet thank yous” from other advocates for bringing attention to this issue, but so far, no word from funders themselves.

“There are lots of folks who are committed and even on my own board,” Tietz told Myrow. “I have white gay men who give and give and give. There are folks who are really doing their part. But the big picture has changed and not for the better.”

As a public health student for the last seven years, I’ve attended my share of research conferences. But the moment I arrived in Washington for the 19th International AIDS Conference, I knew instantly that this one would be different.

Unlike other conferences I’ve attended, the history of the International AIDS Conference is filled with controversy. I could pick many different starting points, but how about the travel ban? The International AIDS Conference had not been held in the U.S. in 22 years because HIV-positive individuals were barred from entering the United States. Congress voted to lift the ban in 2010, and D.C. was promptly chosen as the host city for this year’s conference.

But as the conference began and American speakers took pride in finally having the opportunity to be the hosts, I quickly learned that the travel ban was still in force for some people. HIV-positive sex workers from outside the U.S. are still prohibited from traveling to the U.S.

Activists from across the country, including many from San Francisco, carried red umbrellas and signs, and interrupted sessions in protest of the travel ban and arrest risk from carrying condoms.

Democratic Congresswoman Barbara Lee, who represents Oakland and other cities in San Francisco’s East Bay region, had introduced the original legislation to lift the travel ban and says sex workers should also be allowed to travel to the country.

“I don’t know how we’re going to ever see an end to AIDS in our lifetime – and we believe we can, especially with scientific advances – and have an AIDS-free generation, without including all of those populations who must be involved as part of this solution,” she told the crowd at the opening ceremony.

Regardless of the protests, more than 23,000 people from 183 countries attended the weeklong conference. And that’s just the people who were registered. Then there are all the people who attended one of the conference’s highlight activities — the Global Village, open to the general public at no cost.

People and organizations from around the world held nearly 300 activities and events. Oakland native Roxanne Hanna-Ware gave a spoken word performance called “Crimson Words” about her life as an HIV-positive woman and the stigma that exists along with it.

Also in the Global Village were exhibits of artwork about HIV/AIDS issues and cultural performances by SWING (Service Workers In Group), an HIV prevention and care program for male and transgendered sex workers in Thailand. Many sessions in the conference were broadcast into the Global Village for public viewing.

For registered conference attendees, the daily plenary sessions were generally the highlight activities that drew in the most people. They featured high-profile speakers including Phill Wilson, the Executive Director of the Black AIDS Institute, and Secretary of State Hillary Clinton. However, these sessions were also the target of many protesters.

“What would an AIDS conference be without a little protesting,” joked Secretary Clinton, as she stood on stage in front of activists protesting President Obama’s trade policies.

But even with all of the presentations on the latest HIV/AIDS research, there is still no cure for the disease that has killed nearly 30 million people globally. Instead, many speakers declared that there are still many battles to fight and that we’ve only reached the beginning of the end of the HIV/AIDS epidemic.

Speakers including musician Elton John pointed to stigma and homophobia as challenges to future HIV/AIDS prevention efforts.

“We have to replace the shame with love. We have to replace the stigma with compassion. No one should be left behind,” I watched him say to a room full of people.

During the closing ceremony last Friday, California Congresswoman Nancy Pelosi praised the efforts in fighting AIDS but warned that the battle against the disease is far from over.

“This optimism must not make us complacent. It cannot. It must instead heighten our resolve. We have an obligation to be innovative and courageous in our thinking,” said Congresswoman Pelosi, “Where there is scientific opportunity, we have a moral obligation to fund it. Where there are people in need of drugs and care, communities in need of protection, we have a moral obligation to provide it. And where there is discrimination, we have a moral obligation to continue to fight it.”

The next International AIDS Conference will be held in the summer of 2014 in Melbourne, Australia.

Research presented this week at the 19th International AIDS Conference shows how homophobia may be a major barrier to achieving the “AIDS-free generation” — the optimistic tagline underlying much of the conference.

A new survey of young men who have sex with men (MSM) shows that “experiencing homophobia” may put them at greater risk of contracting and spreading HIV, the virus that causes AIDS.

The study was conducted by Oakland’s Global Forum on MSM and HIV (MSMGF). Researchers surveyed more than 5,000 MSM globally. Nearly 1,500 were age 30 or younger, with about two-thirds of these young men from Asia and six percent from North America. According to the study, young MSM who experienced homophobia more frequently said they had less access to a variety of services including free HIV testing and condoms. Experiencing higher levels of homophobia equated with less access to medical treatment for HIV-positive gay men.

Young MSM who experienced homophobia more frequently said they had less access to a variety of services including free HIV testing and condoms.

“Our findings really underscore the importance of also addressing the larger structure and social factors that are associated with HIV infection especially among young men who have sex with men,” said Glenn-Milo Santos, an epidemiologist and MSMGF researcher.

In addition to highlighting the possible relationship between experiencing homophobia and having less access to HIV preventive services and care, Santos also presented results about respondents’ overall experiences with homophobia.

More than 60 percent of young MSM interviewed said they believed that people in their respective countries felt that gay men and MSM could not be trusted. Seventy percent felt that others believed that they are dangerous. Additionally, the majority of those interviewed said they believed MSM are tolerated but not accepted.

What shocked many audience members attending Santo’s presentation, however, was the rate of internalized homophobia or the negative feelings people have about themselves based on their homosexuality.

Roughly 40 percent of the young MSM said they wished they weren’t gay or bisexual. More than 30 percent said they avoided personal or social involvement with other men who have sex with men. More than 20 percent said their sexual history was a “negative feature” of who they are.

"Internalized homophobia" among young men who have sex with men. (Source: Global Forum on MSM & HIV)

Overall, young MSM had higher levels of this internalized homophobia than older MSM.

“It was really surprising … that we found evidence of high internalized and external homophobia among young men who have sex with men,” Santos told me. “Each of these factors was independently associated with reduced access to HIV prevention services that are critical to reducing exposure to HIV.”

Santos thinks that future efforts aimed at preventing the spread of HIV should consider social factors such as homophobia in order to be effective among the younger MSM population.

“I don’t think that we’re going to achieve our goal of achieving zero new infections without addressing … external homophobia and alleviating internalized homophobia among young men who have sex with men,” Santos said.

Researchers interviewed more than 300 people, including current and former sex workers in four major U.S. cities — San Francisco, L.A., Washington, DC and New York. They found that police officers were either confiscating or taking photographs of sex workers’ condoms as evidence of prostitution, putting sex workers at risk.

“Sex workers on the street are telling us that they are having unprotected sex with clients as a result of this practice,” said Megan McLemore, Senior Researcher at Human Rights Watch.

In L.A., New York and Washington, police confiscated the condoms and used them as evidence, but San Francisco police instead photographed the condoms before giving them back to sex workers. “They have some awareness that they shouldn’t actually be taking away the condoms permanently but we still consider that to be a confiscation because the condoms are seized,” McLemore said. “They’re targeted as evidence, and it still has the same chilling effect on people who don’t want to be harassed for condoms,” she added.

San Francisco’s anti-prostitution enforcement also differs from that of the other cities by targeting prostitution less on streets and more in businesses such as erotic dance clubs, massage parlors, and transgender nightclubs.

According to the report, the focus on businesses has interfered with the clubs’ willingness to have condoms available on their premises in a few cases.

“This undermines the efforts of the San Francisco Department of Public Health which has specifically targeted sex workers and transgendered women … for part of their condom distribution campaign,” McLemore told me.

But according to McLemore, many sex workers that her team interviewed were afraid to carry more than three condoms, meaning they might run out — putting them at risk of having unprotected sex with clients.

“Nowhere in the country is it illegal to carry above a certain number of condoms,” McLemore said. “That was the misinformation. That was another consequence of this.”

Tuesday afternoon, Officer Albie Esparza, public information officer for the San Francisco Police Department acknowledged the department’s policy to photograph condoms as evidence for prostitution charges.

Last week San Francisco Police Chief Greg Suhr sent a department-wide memo reminding officers “not to confiscate unopened condoms.” But the memo added that officers may photograph condoms to establish “probable cause for ‘Loitering for the Purpose of Prostitution.”

McLemore says Human Rights Watch plans to continue its research in other California cities including Oakland. “There have been some reports in Oakland,” McLemore said. “They weren’t consistent enough during the time that we were researching this report to include Oakland but that doesn’t mean that it is not happening in Oakland.”

Naomi Akers, Executive Director of San Francisco’s St. James Infirmary — a health care and social services agency for sex workers — is in Washington to attend the AIDS conference. Her goal is to raise international awareness about human rights for sex workers. Locally, she also said she hopes to meet with the SFPD to discuss policies around condoms.

McLemore is pushing for such a meeting to happen but says it must also bring together the District Attorney, Department of Public Health, and other members of the community to make sure that public officials follow through in taking action.

“The next step is to work with advocates in each of the cities to develop a specific advocacy plan and some goals and some targets and start meeting with public officials and pushing them to take action,” McLemore said.

]]>http://ww2.kqed.org/stateofhealth/2012/07/24/carrying-condoms-brings-arrest-risk-for-sex-workers/feed/0Condoms with a political message, handed out at the International AIDS Conference by St. James Infirmary, a San Francisco health clinic for sex workers. (Photo: Alvin Tran)Condoms with a political message, handed out at the International AIDS Conference by St. James Infirmary, a San Francisco health clinic for sex workers. (Photo: Alvin Tran)FDA Approves First Drug to Help Prevent HIV Infectionhttp://ww2.kqed.org/stateofhealth/2012/07/16/fda-approves-first-drug-to-help-prevent-hiv-infection/
http://ww2.kqed.org/stateofhealth/2012/07/16/fda-approves-first-drug-to-help-prevent-hiv-infection/#commentsMon, 16 Jul 2012 17:53:31 +0000http://blogs.kqed.org/stateofhealth/?p=7353(Justin Sullivan: Getty Images)

The Food and Drug Administration has approved Truvada, the first drug shown to reduce the risk of HIV infection in people who are at high risk of acquiring HIV, the virus that causes AIDS.

Truvada was already approved as a medication for treatment of people already infected with HIV.

Truvada is to be taken twice a day in what is known as pre-exposure prophylaxis, or PrEP.

As part of PrEP, HIV-uninfected individuals who are at high risk will take Truvada daily to lower their chances of becoming infected with HIV should they be exposed to the virus. A PrEP indication means Truvada is approved for use as part of a comprehensive HIV prevention strategy that includes other prevention methods, such as safe sex practices, risk reduction counseling, and regular HIV testing.

“Today’s approval marks an important milestone in our fight against HIV,” said FDA Commissioner Margaret A. Hamburg, M.D. “Every year, about 50,000 U.S. adults and adolescents are diagnosed with HIV infection, despite the availability of prevention methods and strategies to educate, test, and care for people living with the disease. New treatments as well as prevention methods are needed to fight the HIV epidemic in this country.”

Two large studies (both randomized, double-blind, placebo-controlled) showed Truvada’s efficacy in reducing the risk of HIV infection in uninfected individuals. In one trial, 2,499 HIV-negative men and transgender women who have sex with men and engage in high risk behavior for HIV infection, results showed Truvada reduced the risk of HIV infection by 42 percent.

In a study of 4,758 heterosexual couples where one partner was HIV-positive and the other was not, Truvada reduced the non-infected partner’s risk of becoming infected by 75 percent.

Last summer, KQED’s News Fix editor Jon Brooks interviewed Dr. Paul Volberding, co-director of the Center for AIDS Research at the University of California, San Francisco, about the research into Truvada up to that time. Volberding said results showed “the kind of effect we might expect from a very good vaccine.” They also discussed what populations might consider using Truvada as a prophylactic and whether giving healthy people a preventative drug might induce them to engage in riskier sexual activity.

Frontline’s two hour documentary “Endgame: AIDS in Black America” premiered last night on PBS. As we posted here yesterday, nearly half of all Americans infected with HIV are black men, women and children, despite the fact that blacks make up only 12 percent of the population.

In “Endgame,” filmmaker Renata Simone illuminates the hidden history of what could have been a preventable epidemic.

Today, Frontline hosts a live chat with the filmmaker and other guests. You can join the chat below:

When the AIDS epidemic began thirty years ago, it was portrayed by the media as a white, gay man’s disease. As depicted in a Frontline documentary premiering Tuesday night on PBS, that wasn’t the complete story then, and it’s not the case now.

“ENDGAME: AIDS in Black America” shows the tremendous disparity the HIV/AIDS epidemic has unleashed on the black community in the U.S. As Renata Simone, the documentary’s producer and director, described on KQED’s Forum Tuesday morning, African Americans make up about 12 percent of the nation’s population, but account for almost half of all people infected with HIV, the virus that causes AIDS. “Everyday, about 156 people get infected with HIV and half are black,” she told Forum host Michael Krasny.

The documentary features personal stories and interviews from HIV-positive individuals who come from black communities across the country including Oakland. Simone interweaves the role of prejudice, stigma, drugs and prostitution in contributing to the spread of HIV deep in the black community.

Jesse Brooks, an Oakland AIDS activist featured on ENDGAME, also joined Simone on Forum to share his personal experience of coming out and living with HIV. Brooks reminded listeners that the letter ‘H’ in H-I-V stands for ‘human.’ “If we got that in the beginning, that it was a human virus, instead of a white, gay male virus, we wouldn’t be where we are now,” Brook asserted.

Brooks and Simone also addressed the HIV/AIDS disparities among black communities in San Francisco and Oakland. In her documentary, Simone uses San Francisco Bay as a ‘motif.’ “The Bay Area having the bridge and the bay, it’s very visual,” she says. It highlights “bridges and gulfs between populations.” According to Simone, San Francisco gets a lot of attention over HIV/AIDS but Oakland does not.

But Brooks thinks the “culture of silence” in the Bay Area is changing. “When HIV/AIDS came out, there was big, loud voices in San Francisco, and Oakland was silent,” he added. “We can’t afford to be silent anymore.”

East Bay resident Nel Davis contracted HIV from her husband. Davis told Forum that she was pressured by her pastor and members of her family to press charges against her husband for giving her the virus despite being aware of his status. Davis’ story is just one of many that Simone says she encountered while filming her documentary. “The tragedy is that each of the people in the film is not alone,” Simone says. “There are people like every one of them across the country.”

The three guests pointed to lack of condom distribution programs in state prisons, abstinence-based approaches in schools, and drug-use as contributors to the HIV/AIDS epidemic. But all of them hinted that it is primarily stigma against male homosexuality that perpetuates the ongoing challenges of the HIV/AIDS epidemic.

“Stigma has killed people,” Brooks said. “People would rather die than to go into a clinic [with an illness] that might be perceived as AIDS because they might be perceived as gay.”

Beginning this October, Americans will have the opportunity to test themselves for HIV in the comfort and privacy of their own homes. The OraQuick In-Home HIV Test will be the first ever self-administered HIV-test made available for over-the-counter purchase.

The Food and Drug Administration approved the test earlier this week, but it warned the test’s results are a “preliminary” diagnosis, so check-ups are still necessary. Some Bay Area researchers said a key challenge will be ensuring that people actually seek out a confirmation test and additional services from their doctors, regardless of testing positive or negative for the virus.

“They have to know the test may take a while to become positive. It may take several months. If they’ve had a very recent exposure, getting a negative test result is not enough.”

According to the FDA, a positive test does not necessarily mean a person is HIV-positive. The FDA suggests that people who test positive to quickly seek confirmation with their doctors.

People with a negative test should also be wary. A negative test does not mean a person is free from HIV. Susan Buchbinder, MD, the Director of HIV Research Section at the San Francisco Department of Public Health, and a former panel member on the FDA’s advisory committee that recommended OraQuick’s approval, said OraQuick can’t determine if a person has contracted HIV within the past three months.

“If they [test] HIV-negative but may have had recent exposures, they have to know the test may take a while to become positive,” Buchbinder said. “It may take several months. If they’ve had a very recent exposure, getting a negative test result is not enough.”

Regardless of the diagnosis, Buchbinder urges people to quickly seek an additional test to confirm their results with a doctor. She said she is also concerned about how people will perceive their test results, and the potential effects of stigma. “There could be some psychological harm [and] there could be social harm if somebody found out that you were testing and thereby inferred something about you.”

As opposed to being tested at a clinic or in a hospital, Buchbinder said people using in-home HIV test won’t have the benefit of a doctor or health care provider’s counseling services when they get their results.

However, Buchbinder said people do have access to a 24-hour, toll-free number linking them to a supportive services. She added that it may be helpful for people to test with someone they trust, and would feel comfortable being close to, once they get their results.

Though there are concerns, Buchbinder said she believed that the new test has the potential to change people’s risk behaviors. “It has the potential to reduce new infections by getting people who learn that they’re infected into care and treatment, and [reduces] the risk of exposure to HIV-negative individuals,” she said. “[But] we won’t know until we actually see how this rolls out.”

Buchbinder said she also hopes that OraQuick users will share all of their positive and negative experiences. “The more information we get back from the community about what’s working and what’s not working, the better able we are to build services and build programs that can support people,” she said.

The San Francisco Public Health Department is currently working on strategies to figure out the most effective means of using OraQuick in local areas where testing rates are lower and where there is a higher rate of health risk behaviors.

A panel of federal health advisers has endorsed the first drug shown to prevent HIV infection in healthy people, clearing the way for a potentially landmark approval in the 30-year-old effort against the virus that causes AIDS.

In a series of votes, the Food and Drug Administration advisory panel recommended approval of the daily pill Truvada for healthy people who are at high risk of contracting HIV, including gay and bisexual men and heterosexual couples with one HIV-infected person. The FDA is not required to follow the panel’s advice, though it usually does. A final decision is expected by June 15.

Drugmaker Gilead Sciences Inc., of Foster City, already markets Truvada as a treatment for people who are infected with HIV.

Last July, KQED’s News Fix editor Jon Brooks interviewed Dr. Paul Volberding, co-director of the Center for AIDS Research at the University of California, San Francisco, about the research into Truvada up to that time. Volberding said results showed “the kind of effect we might expect from a very good vaccine.” They also discussed what populations might consider using Truvada as a prophylactic and whether giving healthy people a preventative drug might induce them to engage in riskier sexual activity.